Treatment of elevated intracranial pressure in reye syndrome

Trauner, Doris A.; Brown, Frederick D.; Ganz, Edward; Huttenlocher, Peter R.

doi:10.1002/ana.410040315

Cited by 26 publications

(3 citation statements)

References 12 publications

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“…Continuous ICP monitoring remains a useful tool in the management of patients in NICU [47,48]. In this study, we used a new ventricular catheter which enables continuous ICP monitoring even during CSF drainage to study cerebral vascular changes during acute ICP drop.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Vascular Changes During Acute Intracranial Pressure Drop

Liu

Zimmermann

et al. 2018

Neurocrit Care

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Objective: This study applied a new external ventricular catheter, which allows intracranial pressure (ICP) monitoring and cerebral spinal fluid (CSF) drainage simultaneously, to study cerebral vascular responses during acute CSF drainage.Methods: Six patients with 34 external ventricular drain (EVD) opening sessions were retrospectively analyzed. A published algorithm was used to extract morphological features of ICP recordings, and a template-matching algorithm was applied to calculate the likelihood of cerebral vasodilation index (VDI) and cerebral vasoconstriction index (VCI) based on the changes of ICP waveforms during CSF drainage. Power change (∆P) of ICP B-waves after EVD opening was also calculated. Cerebral autoregulation (CA) was assessed through phase difference between arterial blood pressure (ABP) and ICP using a previously published wavelet-based algorithm. Results:The result showed that acute CSF drainage reduced mean ICP (P = 0.016) increased VCI (P = 0.02) and reduced ICP B-wave power (P = 0.016) significantly. VCI reacted to ICP changes negatively when ICP was between 10 and 25 mmHg, and VCI remained unchanged when ICP was outside the 10-25 mmHg range. VCI negatively (r = − 0.44) and VDI positively (r = 0.82) correlated with ∆P of ICP B-waves, indicating that stronger vasoconstriction resulted in bigger power drop in ICP B-waves. Better CA prior to EVD opening triggered bigger drop in the power of ICP B-waves (r = − 0.612). Conclusions:This study demonstrates that acute CSF drainage reduces mean ICP, and results in vasoconstriction which can be detected through an index, VCI. Cerebral vessels actively respond to ICP changes or cerebral perfusion pressure (CPP) changes in a certain range; beyond which, the vessels are insensitive to the changes in ICP and CPP.

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Section: Discussionmentioning

confidence: 99%

Cerebral Vascular Changes During Acute Intracranial Pressure Drop

Liu

Zimmermann

et al. 2018

Neurocrit Care

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“…Continuous ICP monitoring remains a useful tool in the management of patients in NICU [27,28]. A significant reason for death and long-term disability due to head injuries and other intracranial pathological conditions is an elevation in the ICP [1].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a New Catheter for Simultaneous Intracranial Pressure Monitoring and Cerebral Spinal Fluid Drainage: A Pilot Study

Liu

Zimmermann

et al. 2018

Neurocrit Care

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Objectives: Intracranial pressure (ICP) monitoring is a common practice when treating intracranial pathology with risk of elevated ICP. External ventricular drain (EVD) insertion is a standard approach for both monitoring ICP and draining cerebrospinal fluid (CSF). However, the conventional EVD cannot serve these two purposes simultaneously because it cannot accurately measure ICP and its pulsatile waveform while the EVD is open to CSF drainage. A new Integra ® Camino ® FLEX Ventricular Catheter (Integra Lifesciences, County Offaly, Ireland) with a double-lumen construction has been recently introduced into the market, and it can monitor ICP waveforms even during CSF drainage. The aim of this study was to evaluate and validate this new FLEX catheter for ICP monitoring in a neurological intensive care unit. Methods: Six patients with 34 EVD open/close episodes were retrospectively analyzed. Continuous ICP was detected in two ways: through the FLEX sensor at the tip (ICP f) and through a fluid-coupled manometer within the FLEX catheter, functioning as a conventional EVD (ICP e). The morphologies of ICP f and ICP e pulses were extracted using Morphological Clustering and Analysis of ICP algorithm, an algorithm that has been validated in previous publications. The mean ICP and waveform shapes of ICP pulses detected through the two systems were compared. Bland-Altman plots were used to assess the agreement of the two systems. Results: A significant linear relationship existed between mean ICP f and mean ICP e , which can be described as: mICP f = 0.81 × mICP e + 1.67 (r = 0.79). The Bland-Altman plot revealed that no significant difference existed between the two ICPs (average of [ICP e-ICP f ] was − 1.69 mmHg, 95% limits of agreement: − 7.94 to 4.56 mmHg). The amplitudes of the landmarks of ICP pulse waveforms from the two systems showed strong, linear relationship (r ranging from 0.89 to 0.94). Conclusions: This study compared a new FLEX ventricular catheter with conventional fluid-coupled manometer for ICP waveform monitoring. Strong concordance in ICP value and waveform morphology between the two systems indicates that this catheter can be used for reliability for both clinical and research applications.

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“…4 Monitoring intracranial pressure (ICP) is now standard in the management of moderate and severe cases of RS, 5 with mannitol the osmotic diuretic of choice. [2][3][4][5][6][7][8][9][10][11][12][13][14] However, studies of the serum and cerebrospinal fluid (CSF) concentrations of mannitol in RS therapy raise serious questions about the prolonged and indiscriminate use of this drug.…”

mentioning

confidence: 99%

Mannitol crosses the blood-brain barrier in Reye's syndrome

Orlowski¹

1982

Cleveland Clinic Journal of Medicine

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Treatment of elevated intracranial pressure in reye syndrome

Cited by 26 publications

References 12 publications

Cerebral Vascular Changes During Acute Intracranial Pressure Drop

Cerebral Vascular Changes During Acute Intracranial Pressure Drop

Evaluation of a New Catheter for Simultaneous Intracranial Pressure Monitoring and Cerebral Spinal Fluid Drainage: A Pilot Study

Mannitol crosses the blood-brain barrier in Reye's syndrome

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